Collective Action

Collective Action is the operational work that people do to enact a set of practices, whether these represent a new technology or complex healthcare intervention. Like all NPT constructs, it has four components. These were the first NPT constructs to be developed and their names reflect qualities of technologies or complex interventions, rather than the character of the work that these involve.

3.1 Interactional Workability: This refers to the interactional work that people do with each other, with artefacts, and with other elements of a set of practices, when they seek to operationalize them in everyday settings. For example, a key problem of telemedicine systems has been shown to be their negotiation by doctors and patients as they try to communicate complex clinical information each other over a videoconferencing link.

3.2 Relational Integration: This refers to the knowledge work that people do to build accountability and maintain confidence in a set of practices and in each other as they use them. A telemedicine system that transmitted clinical images of skin lesions ran into trouble when individual doctors began to lose confidence in what these images actually represented, and started to examine patients in parallel to digitized images - thus doubling their workload and putting their clinical department under pressure.

3.3 Skill set Workability: This refers to the allocation work that underpins the division of labour that is built up around a set of practices as they are operationalized in the real world. Who gets to do the work is an important element of any set of practices. For example, a core problem for a research group investigating the effectiveness of a decision aid for medication choice after a a serious illness event was whether the decision aid should be administered by trial managers with no clinical responsibility for the patient, or nurse practitioners actively involved in their care. Allocating the work to the former meant that the decision aid was more easily delivered, but trial managers lacked the clinical expertise of the nurse practitioners which meant that it was hard for them to answer patients' questions.

3.4 Contextual Integration: This refers to the resource work - managing a set of practices through the allocation of different kinds of resources and the execution of protocols, policies and procedures. Typically, the implementation of a new set of practices is seen as a management problem, and it's true that the power to allocate resources and define the processes by which new technologies or complex interventions are executed in practice. The work that is involved in this is about resourcing.g the ways that others enact a new set of practice.